Tuberculosis (TB) is one of the world's leading causes of mortality – in 2019, it was estimated that nearly 10 million people developed the disease . In the region of the Americas, only 65% of estimated TB cases are detected by health systems, and pediatric TB accounts for 5.5% of total cases . Peru has the second highest number of TB cases among countries in the Americas .
Given such a high disease prevalence, prevention of TB through the use of preventive treatment is critical for elimination strategies . Contacts of TB patients are a priority group for preventive treatment because of their high risk of developing TB disease . Prompt initiation of preventive treatment, appropriate monitoring, and support for contacts can reduce the risk of developing TB in exposed individuals .
Appropriate staffing and training of health personnel are important factors in improving TB prevention and management . The World Health Organization (WHO) recommends that countries assess health system infrastructure, staffing of healthcare workforce, and training to implement contact tracing and preventive treatment in health centers . More evidence is needed to support fair and adequate distribution of human resources in health centers, based on the prevalence of TB and risk of transmission in a given area.
Although the proper implementation of international standards for TB prevention could prevent the deaths of thousands of children and adolescents around the globe , initiation and maintenance of preventive treatment is poor . Various countries have reported non-compliance with policies aimed at medical management of TB contacts . Most research that focuses on TB contacts in minors less than 18 years of age evaluates the administration of the purified protein derived (PPD) skin test and completion of a 24-week course of isoniazid preventive therapy (IPT) [10–12]. There are fewer studies that evaluate other aspects of TB contact care, such as the timely onset of IPT and proper clinical evaluation with follow-up medical appointments . Peruvian TB guidelines indicate that TB contacts 19 years or younger should receive a PPD test and 24 weeks of IPT if the PPD result is positive. For TB contacts less than five years of age, the guidelines recommend IPT without requirement of a PPD test .
Weak health systems hinder TB control efforts . The WHO classifies the health workforce as an essential building block for strong health systems. This includes a sufficient, competent, and equitably distributed group of healthcare workers that can improve health outcomes . Healthcare workers are especially vital in resource-constrained areas, such as Lima, where social determinants of health such as transportation, health-seeking behaviors, and material resources have been shown to impede patient access to care [17, 18]. In 1990, Peru’s National TB Program (NTP) became a national health priority, and since then there have been increased funds and political commitment to the NTP . Despite this, however, Lima continues to face a lack of qualified and well-trained staff in the city’s most impoverished areas, where the public health system may lose healthcare staff to private or international health bodies .
It is essential to generate evidence about health personnel staffing at the primary care level of decision-making in attempts to reduce health inequities and improve TB prevention. The objective of the study is to determine the association between health center characteristics, including available human resources, and effective IPT management in southern Lima.